Validating indicators of treatment response: Application to trichotillomania.

Nelson, Samuel O.; Rogers, Kate; Rusch, Natalie; McDonough, Lauren; Malloy, Elizabeth J.; Falkenstein, Martha J.; Banis, Maria; Haaga, David A. F.

doi:10.1037/a0036333

Cited by 15 publications

(15 citation statements)

References 35 publications

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“…It is important that gold standard outcome variables are established in TTM treatment studies to afford future cross-study comparisons. Nelson et al (in press) evaluated the relative validity of seven indicators of treatment response (complete abstinence, and as measured by the MGH-HPS and PITS >=25% symptom reduction, recovery of normal functioning, and clinical significance) with the full sample in this study, and found that clinically significant improvement on the MGH-HPS had the strongest results. They also recommended the use of data on complete abstinence as a supplementary metric.…”

Section: Resultsmentioning

confidence: 99%

Predictors of relapse following treatment of trichotillomania

Falkenstein

Rogers

Malloy

et al. 2014

Journal of Obsessive-Compulsive and Related Disorders

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Objective This study sought to identify predictors of relapse in a behavior therapy trial for trichotillomania (TTM), or hair-pulling disorder. Relapse is common after treatment for TTM, and only a few studies have examined what might predict relapse. Method Data was examined from a TTM treatment study with a stepped-care approach (step 1. web-based self-help; step 2. individual behavior therapy) (N = 60). Implications of significant predictive relations were illustrated by constructing Probability of Treatment Benefit (PTB) charts (Lindhiem, Kolko, & Cheng, 2012), which quantify the probability of maintaining gains according to predictors of maintenance. Results Abstinence at the conclusion of treatment and lower TTM severity during initial response significantly predicted maintenance. Abstinence periods prior to treatment, residual urges after achieving abstinence, pre-treatment TTM severity, intrinsic motivation, and treatment compliance did not predict maintenance. Conclusions Post-treatment abstinence and lower TTM severity during initial response predicted maintenance. Replications of this research are needed to determine the usefulness of these possible predictors in identifying relapse-prone patients, with the aim of improving clinical decision-making and developing strategies to help these patients better maintain gains. This is the first TTM study to use PTB charts, which can help clarify the meaning of prognostic analyses.

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Section: Resultsmentioning

confidence: 99%

Predictors of relapse following treatment of trichotillomania

Falkenstein

Rogers

Malloy

et al. 2014

Journal of Obsessive-Compulsive and Related Disorders

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“…With these scaling limitations in mind, clinicians should consider both raw score and percent reductions when determining whether a particular client has significantly responded to treatment or recovered from TTM. Researchers should also consider which criterion of improvement is most important to use when powering a study, as judgments of treatment efficacy could be expected to significantly vary depending on this question (Nelson et al, 2014). …”

Section: Discussionmentioning

confidence: 99%

“…A recent study examined the ability of changes in the MGH-HPS and another clinician-rated measure of hair pulling severity, the Psychiatric Institute Trichotillomania Scale (PITS; Winchel et al, 1992) to predict various meaningful outcomes (Nelson et al, 2014). Various potential clinical predictors were used, including Jacobson and Truax’s (1991) clinically significant change criteria (i.e., 1.96 times the reliable change index plus a post-treatment score that was two standard deviations below the dysfunctional population mean), complete abstinence from pulling (defined as a score of 0 on MGH-HPS item 4), 25% reduction on the MGH-HPS or PITS, and the recovery criterion alone (e.g., score of ≤ 9 on the MGH-HPS or ≤ 14 on the PITS).…”

Section: Introductionmentioning

confidence: 99%

Defining treatment response in trichotillomania: a signal detection analysis

Houghton

Capriotti

Nadai

et al. 2015

Journal of Anxiety Disorders

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The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale (NIMH-TSS) are two widely used measures of trichotillomania severity. Despite their popular use, currently no empirically-supported guidelines exist to determine the degrees of change on these scales that best indicate treatment response. Determination of such criteria could aid in clinical decision-making by defining clinically significant treatment response/recovery and producing accurate power analyses for use in clinical trials research. Adults with trichotillomania (N = 69) participated in a randomized controlled trial of psychotherapy and were assessed before and after treatment. Response status was measured via the Clinical Global Impressions-Improvement Scale, and remission status was measured via the Clinical Global Impressions-Severity Scale. For treatment response, a 45% reduction or 7-point raw score change on the MGH-HPS was the best indicator of clinically significant treatment response, and on the NIMH-TSS, a 30–40% reduction or 6-point raw score difference was most effective cutoff. For disorder remission, a 55–60% reduction or 7-point raw score change on the MGH-HPS was the best predictor, and on the NIMH-TSS, a 65% reduction or 6-point raw score change was the best indicator of disorder remission. Implications of these findings are discussed.

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“…To avoid the criticism of meta‐analyses for “mixing apples with oranges” (Higgins & Green, ), sensitivity analyses were conducted; the inclusion of some heterogeneity can be a strength due to results being transferable and more robust (NHMRC, ). To minimise heterogeneity between studies, the MGH‐HPS or the most similar measure to the MGH‐HPS was used for analysis in accordance with recent recommendations on the use of outcome measures for TTM (Nelson et al, ).…”

Section: Methodsmentioning

confidence: 99%

A systematic review and meta‐analysis of behaviourally based psychological interventions and pharmacological interventions for trichotillomania

Slikboer

Nedeljkovic

Bowe

et al. 2017

Clinical Psychologist

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Background: Trichotillomania (hair-pulling disorder) is a debilitating and distressing disorder associated with great secrecy and shame. A lack of understanding regarding interventions for Trichotillomania contributes to poor routine outcomes for the disorder.Method: This systematic review and meta-analysis assessed the efficacy of behaviourally based psychological interventions and pharmacological interventions for trichotillomania compared to a range of control groups. Participants were adults who have been diagnosed with trichotillomania. A systematic search was conducted of the Cochrane library, EBSCOhost, MEDLINE before 1966, and Google Scholar for relevant randomised controlled trials.Results: Of the total 462 records identified, 12 studies were included in the quantitative synthesis, and nine studies were included in meta-analyses.Conclusions: Analyses revealed that-from medication approachesfluoxetine was not found to be efficacious. However, N-acetyl cysteine, clomipramine, and olanzapine showed potential for the treatment of trichotillomania. Regarding psychotherapy, behaviour therapy showed superior efficacy when compared to a passive control group. However, when behaviour therapy was compared to an active control group (progressive muscle relaxation, supportive therapy), both conditions showed similar efficacy in treating trichotillomania. It was concluded that the psychological mechanisms in trichotillomania may be more complex than the behavioural model indicates. Implications and limitations are discussed. Key Points1 Support was found for the superiority of psychological treatment for trichotillomania over medications. 2 Results add to the increasing evidence that suggests SSRIs have little to no efficacy for the treatment of trichotillomania. 3 The role of non-technique-based social support, selfhelp activities, and generic therapeutic factors are important when treating trichotillomania.

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Validating indicators of treatment response: Application to trichotillomania.

Cited by 15 publications

References 35 publications

Predictors of relapse following treatment of trichotillomania

Predictors of relapse following treatment of trichotillomania

Defining treatment response in trichotillomania: a signal detection analysis

A systematic review and meta‐analysis of behaviourally based psychological interventions and pharmacological interventions for trichotillomania

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